Trauma and Recovery

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The same route to work, the coffee shop with its signature offering, regular weekly appointments, the grocery shop with its familiar layout and stock on the shelves: these are the structures which allow us experience a rhythmic flow to our lives with disruptions within the boundaries of the expected. Just as routine carries us, so it allows us to avoid thinking about the fundamental uncertainty of life and the possibility of radical disruption. Every now and then, unexpected events upend what we think we know about the structure of our lives, challenging our foundations. What do we hold on to?

Among the possible sequelae of trauma is the sense of ‘shattered assumptions’[i]related to the deviation from our core expectations of the way life is. Ronnie Janoff-Bulman first wrote about her theory of ‘shattered assumptions’ in 1992[ii], arguing that we tend to carry implicit, undeclared assumptions about the world as benevolent, meaningful, and predictable. Traumatic events have the potential to disrupt our core schema, shattering taken-for-granted assumptions. Each individual’s implicit assumptions about the world are unique, suggesting that in turn, each person’s response to traumatic events is unique and impacted by prior experiences, cognitive schema and personality structure.

As much as the trauma is a real external event, the impact of the trauma in the external world is always mediated by the individual’s internal world[iii]. Janoff-Bulman’s understanding of individual response to trauma arises from a cognitive perspective, proposing disruption of core schema as a key mechanism of the trauma response. A psychoanalytic perspective on the nature of the internal world offers related, but additional insights into the disruption caused by traumatic events.

The Kleinian approach to psychoanalysis suggests that each individual faces the task of internalising a robust good object. A preponderance of good, nurturing early experiences aids this internalisation, helping the individual to arrive at a point where he or she experiences the self and relationships as generally benign, and allowing the individual to ‘stand up’ to the bad object, whether it comes in the form of a critical inner voice, a self-destructive part of the self, or a malignant relationship. Eric Brenman suggests that many dynamics can get in the way of successful internalisation of the good object, and much of the work of psychoanalysis is aimed at recovering a lost good object which was not successfully internalised[iv]. It can be suggested that trauma challenges this process, recapitulating the individual’s struggle to establish a solid sense of goodness in the self and in the world. It is as if the real external bad experience lends weight to early persecutory anxieties of attack and annihilation.

Most approaches to trauma counselling aim to promote the experience of mastery in the individual[v]: in place of an experience of the self as helpless, the counsellor aims to restore feelings of effectiveness. One technique addressing this therapeutic goal is to help individuals to see how their actions during the event contributed to their survival. This technique can be seen as part of the overall process of re-establishing contact with a robust part of the self which can be relied upon. The recovery of a lost (or temporarily compromised) good object seems to be a core element of the psychotherapy process with survivors of trauma. Sometimes this process is discernible in more subtle ways. For example, after a number of months working together through a trauma, the therapist notices that her patient tends to omit from the trauma narrative the people who came to his aid during and shortly after the traumatic event. Not only are they omitted from his narrative; it is likely that in his internal world, these more benign elements are shrunken and faded. While therapy is not about looking on the bright side, it is about facing and knowing about reality, and the therapist could think about gently bringing the patient’s attention to the more humane elements of the experience, if they exist. The therapy space itself aims to provide a safe, predictable space where together, the therapist and patient can bear witness to and attempt to struggle with elements of experience which may be horrific, frightening and unbearable. Hopefully, the patient can gradually be helped to regain contact with the good object.

My recent musings on trauma debriefing lead me to wonder whether my office can ever be a protected space where trauma is unable to break through the invisible membrane that encloses the therapy room from the world. This raises the question of where we can feel safe, and whether safety is an internal or external experience. So often, traumatised clients are left with fear of a recurrence of a similar kind of event, and I cannot reassure the client that nothing like this will ever happen again, though we can think about the many days which pass without such events and their generally exceptional nature. Where the client is in a situation of continuous traumatic exposure, re-establishing a sense of safety becomes even more difficult.

Perhaps it is not so much about a therapy space which is insulated from trauma, but rather one that is robust enough to allow the client to face and work through it, aided by a therapist who bears witness and takes in the traumatic story. Trauma counselling represents the hope that the trauma can be processed and survived by the self rather than corroding and undermining its structures. As Janoff-Bulman highlights, sometimes traumatic events result in a profound sense of loss of the way the individual previously saw the world, of a treasured belief in the fundamental goodness and neighbourliness of other people. The view of other people feels tainted by interpersonal trauma, where another human being turns on you and threatens harm. Mourning this loss of innocence in one’s perspective may be a painful and sobering experience, where an individual may be compelled to accommodate their worldview in a way that is more in touch with reality, making space for the less benign permutations of human encounters. The playwright Terence of the Roman era said “nothing of that which is human is alien to me”, and I think this is a worthwhile position to try to adopt as a therapist and as a human being. Our willingness to take on clients who have been through trauma is our statement of hope that awful experiences are not beyond the pale of what psychotherapy can contend with. This brings me back to the beginning: what can we hold onto in a fundamentally unpredictable world? For me, the capacity of the mind to make meaning is a good place to start, and the capacity of two minds together to work towards recovery of the lost good object offers hope for recovery from trauma.